Did you feel that? That little jolt in your stomach as you clicked on the headline? Perhaps, your muscles tensed for just a moment? Maybe your heart skipped a beat. What was that? An insignificant flutter? A meaningless moment to shrug off in your busy day?
Perhaps that fleeting feeling is explained by the stigma known all too well to sufferers of chronic mental illnesses. Stigma is fuelled by our fears creating a chasm between those who struggle with mental illness, and those fortunate enough not to have been dealt a bad hand. We bemoan stigma and even claim to be above it. I, as a sufferer of mental illness, could even claim to be immune from it. These assertions, however, are a vain attempt to delude ourselves. Every fleeting thought, subtle comment, and little doubt is stigma rearing its ugly head. Yet perhaps the most damaging form of stigma is that directed inwardly by those suffering from mental illness. This is the stigma we rarely see: the irrational shame, the self-doubt, the relentless fear of relapse.
Doctors continue to take their own lives at alarming rates despite years of awareness campaigns. We employ words like “burnout” and blame systemic failures of an aging population with complex health needs, the ever-increasing paperwork, inadequate sick leave cover or punishing on-call rosters. These challenges are genuine avenues for significant change to improve doctors’ mental wellbeing. But for a moment, let us consider our own biases. Many of us still guardedly believe that fellow doctors who are brave enough to seek help for their mental illness are somehow failing, particularly if they do not immediately recover. Beliefs that those with a history of mental illness are somehow less competent, less reliable, and less trustworthy still perpetuate. I recall being asked some years ago whether I agreed that, “a doctor who gets sick all the time can’t really ever be a good doctor to their patients.” This was not the dated perspectives of an aging doctor of twilight years, but rather those of a bright-eyed medical student, with their whole career ahead of them. Attitudes like these must end if doctors are to feel safe in seeking help for their mental ill-health.
As a psychiatry registrar, what I have found most striking is the profound grief and loss suffered by those diagnosed with a chronic mental illness. “Schizophrenia,” “bipolar disorder,” “personality disorder.” These words invoke fear, indeed terror, in those who hear them, in much the same way that hearing the word “cancer” might. The range of responses to these diagnoses is as varied as the illnesses themselves: denial, bemusement, even aggression. I am often witness to patients who completely shut down on hearing a psychiatric diagnosis. It pains me to see their attempts to negotiate, bargain, or rationalize the incomprehensible nature of their illness. Of course, where a diagnosis like “cancer” differs is in the true, bitter isolation of a psychiatric illness – the cold feeling of having to secretly suffer. Each time I educate a patient about their newly diagnosed illness I feel, in some small way, a shared understanding of their grief. This insight has given meaning and allowed me to accept my own illness. My own illness has allowed me to empathize in a way I may never have been otherwise able.
Fear has dictated that I, and others, hide our emotions and thoughts, lest our secret “unwell” identities be known to those whom we work with or treat. We are one person to our friends, and another to our patients and colleagues. My world has long been controlled by the fear that my professional life would fall apart if people knew my secret. I feared looking pathetic and weak or that I would be perceived as unable to cope. The unspoken obligation to my colleagues to present a bravado and confidence hid what is a daily battle to remain well.
For one day each year, doctors celebrate #crazysocks4docs day. Through the simple, yet brilliant act of wearing odd socks, the change we are driving within our profession is celebrated. An assortment of quirky foot-art is as we smile and laugh at the various colors and patterns, enjoying a brief moment worthy of celebration. For too long, the wounded healer has battled on, overworked in an under-resourced system. For one day, we celebrate doctors’ mental health and wellbeing and call out the challenges leading to burnout, stress, and depression. We shine a light on the need for systemic change to ensure doctors have the best chance to remain well and celebrate our tentative early steps toward genuinely supporting one another.
Through the thousands of bizarrely unmatched soles, sporting spots, stripes and shades dotted around hospitals and clinics across the globe on #crazysocks4docs day, we mustn’t forget that which matters most. Doctors’ mental health is so much more than a hashtag. For many, it is a daily battle. Today, I win this battle, but sometimes do not. The time has come for doctors with mental illness to step out of the darkness. Today, my cloak is dropped, the secrecy thrown out in the hope that others feel a little safer to do the same.
Colleagues, I ask you to celebrate your imperfection. Take a moment to pause. Maybe, even laugh at yourself. To paraphrase Winnicott’s seminal work on the “good enough mother,” I ask you to be the “good enough doctor.” Share your struggles. It is time for us all to hear that it is OK to not be OK. Critically, interrogate your own biases about mental illness, for only then can we foster greater tolerance and acceptance of mental illness. And only then can we hope to reduce the scourge of doctors’ suicides.
And by the way, I have one last thing to say to that doubting medical student of years past. Today I say, yes, I have a mental illness. And I might just be a better doctor for it.
Kieran Allen is a psychiatry registrar in Australia. He can be reached on Twitter @kidsankyran.
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